Editor,The UK Foundation Programme (FP) curriculum recommends that Foundation doctors (FD) develop experience in ‘managing, analysing and presenting at least one quality improvement project and using the results to improve patient care’. While the Maltese FP follows the UKFP recommendations, little emphasis is placed on completion of the audit cycle. The authors devised a questionnaire to assess the proportion of audits performed by FDs at Mater Dei Hospital (MDH) that completed the audit cycle, implementing changes in clinical practice.
METHODS
All audits registered on the Maltese FP audit register between January 2012 and August 2015 were included in the study: a total of 110 projects. The questionnaire was forwarded to the main author of each registered project by electronic mail, and responses collected over 6 months.
RESULTS
57 questionnaires were completed (52%). Most FD embarked on an audit so as to influence practice (79%) or improve the curriculum vitae (72%). 66.6% of respondents felt satisfied with the outcome of their project, while 71% felt supported in performing the audit. 77% of respondents felt encouraged to present their findings. Only 5.2% of audits reached the final, re-audit stage of the audit cycle. The most common reasons for failing to complete the audit loop were time limitations (46.9%), administrative difficulties (25%) and a move to a different department (50%). Of the 94.8% of responders who failed to complete the audit cycle, only 8.9% handed over their work to a colleague to complete.
DISCUSSION
Audits done by FD in Malta were rarely completed, with only 5.2% of the registered audits reaching the re-audit stage. This compares with 24% in a similar study in London. 21% of junior doctors from Leeds perceived their audit projects to have a negative effect on the department the degree of support from audit staff, and the perceived value of the resulting audits. This contrasts with our data showing a relatively high rate of satisfaction with the outcome of the audits performed, regardless of the stage of the audit cycle that was reached. This could indicate a poor appreciation of the potential for audit to influence practice. Also sobering is the fact that of those failing to complete the audit cycle, 91% did not plan to handover their results to a colleague to complete the cycle, and almost 50% had no plans to complete the audit. In these cases, it appears that potentially influential data has gone to waste.The authors propose a handover system for FD to pass on their collected data for a colleague to act upon. This could avoid useful and hard-earned data from going to waste, and lead to improvements in practice. Encouraging multiple FD to work as a team on a single project can also help them overcome time limitations. FD need to be made aware of the value of a completed audit: part of the responsibility for this falls on Educational Supervisors within the FP. Helping junior doctors to contribute by implementing change will motivate them and encourage them to undertake further audit projects in the future.